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MORE ON PROSTATE CANCER AND PEYRONIES
What Your Doctor
May Not Tell You,
Because He Does
Not Know
May Not Tell You,
Because He Does
Not Know
(If you are new to this site or want to review prior articles on this
topic, click the blue lettering on this page).
I began to write about the increased incidence of Peyronie's
Disease (PD) as an outcome of Radical Prostatectomies (RP)
about one year ago. With few exceptions, this relationship was
not discussed in the medical literature and the majority of
urologists failed to advise their patients of this adverse outcome
of prostate cancer surgery.
The further I researched this topic, the more evidence of this
connection was revealed. In a previous edition of this site, I
reviewed the findings of a study conducted by the Sloan-Kettering
Cancer Center. At that time, I only had access to the study
abstract, but now have the complete study.
The study group consisted of 1011 men who were in a sexual
medicine database at the Cancer Center. Inclusion criteria were
men who:
- Underwent RP for prostate cancer
- Were evaluated for sexual dysfunction in the years
- Had a baseline examination by a urologist prior to
surgery. The urologist conducted a focused penile
examination looking for PD plaque. Curvature measurement
was performed on all patients. - Had a sexual medicine evaluation within 3 years after surgery.
Exclusion criteria:
- Additional prostate cancer treatment was administered
- PD diagnosis was made prior to surgery
- Unavailability of PD evaluation data
According to the author, the incidence of PD in the general male
population was difficult to determine as the reported incidence
rate varied widely. One medical review revealed an incidence
rate range of 3.2-8.9%. Clinically, it is believed that reported rates
are unrealistically low as this disease is commonly under-
diagnosed. Further, the existing evidence in the literature to
support or refute the link between RP and the occurrence of PD Is
“remarkably limited.”
The Sloan-Kettering study yielded an overall PD incidence of
15.9%. This PD incidence rate is approximately two-fold greater
than the highest reported incidence rate noted in the literature and
is suggestive of being increased after RP. (A cautionary note is
that a statistical relationship does not definitely prove cause and
effect.) According to their findings, the incidence of the
development of PD after RP seems to develop progressively
within a 3-year period. The average curvature of the study
subjects was 31 degrees.
Urologists Fail to Mention Peyronies Disease
An article in the Journal of Sexual Medicine 2011 1805-1811
confirms the medical profession’s lack of knowledge concerning
PD and its association with RP. This article discusses erectile
function after robotic assisted RP and reinforces my contention
that most urologists are unaware of the relationship between RP
and PD. The article provides a detailed review of erectile function
after RP and states that penile fibrotic changes have long been
implicated as the most important cause of long-term erectile
functioning after RP. The authors totally fail to mention the
increased incidence of PD or even mention the disease at all.
In a related article from a British urological publication, the topic of
medico-legal issues are reviewed. The author points out that
consent issues are often pleaded in clinical negligence claims
arising from surgical practice. Patients frequently allege that
would have not agreed to undergo the procedure if they had
known all the risks associated with it. The author counsels that
the patient should be sufficiently informed to make a considered
decision. It is my opinion that this lack of informed consent occurs
regularly with prostate cancer surgery and the possibility of
development of PD.
Miscellaneous News About Prostate Cancer
A recently published book, Ovediagnosed, presents one
physician’s review of the Cost vs. Benefits of medical screening
and treatment. What is unique about the author is that he has a
statistical background and uses this as his primary approach. He
devotes considerable space to prostate cancer screening and
subsequent adverse treatment side effects. Particularly poignant
is the case of his physician friend who underwent prostate cancer
surgery. Unfortunately, the author does not mention PD in his
analysis. Despite this omission, I highly recommend this book for
a fresh approach to the medical screening issue and prostate
cancer . In the May 07, 2011, issue of the Lancet there is a
generally favorable review of this book and the author's approach.
The reviewer ends by hoping that this book will inspire a new
generation of public health advocates to inform patients of over
diagnosis.
As to confirm the finding that many surgeons may have gaps in
their knowledge of prostate cancer treatment and adverse events,
one study noted that the majority of surgeons who perform RP in
the US have extremely low annual caseloads. This lack of surgical
experience can result in an increased risk of surgical
complications and cancer recurrence. Researchers at Sloan-
Kettering found that more than 25% of surgeons performed only a
single RP in 2005 and 80% had an annual volume of 10 or fewer.
Extensive evidence shows that increased surgeon volume is
associated with improved patients' outcomes with complications
rates 20% lower between the highest and lowest quartiles of
annual caseload. The authors speculated that 250 surgeries would
be the criteria for reaching a proficient plateau.
